ConQual (confidence in the output of qualitative research synthesis) and CERQual (confidence in evidence from reviews of qualitative research) are frameworks developed to grade confidence in synthesized qualitative findings, with variable scope and complexity. These frameworks have been developed for improving transparency and rigor in qualitative research, which is important for guiding evidence-based health and social policies.(1)

ConQual, developed in 2014 within the Joanna Briggs Institute’s (JBI) meta-aggregative model, is based on two domains: dependability, which evaluates methodological quality, and credibility, which determines the association between data and interpretation. Its simplicity makes it suitable for rapid reviews, though experts believe it can limit the framework from making nuanced judgments in complex syntheses.(2-4) As of 2025, conQUAL has been reportedly undergoing ongoing validation and refinement, with updated guidance encouraging precise association between critical appraisal and dependability scoring, as well as transparent use of supporting data for credibility, providing clearer and more consistent confidence rankings for reviewers. While its ordinal system continues to be practical and widely accepted, conQUAL’s latest use focuses on meta-aggregative reviews in health, education, and social policy, wherein the researchers discuss future integration with digital tools and other frameworks to enhance transparency and reporting accuracy.(5-7)

On the other hand, CERQual, developed in 2010, under the GRADE working group and now widely used by Cochrane and Campbell, integrates a four-domain approach: methodological limitations, coherence, data adequacy, and relevance. This framework studies each finding in detail, providing clearer differences between high-, moderate-, and low-confidence findings.(3) The latest 2025 updates to CERQual underline the importance of coherence and relevance, supporting its application in both healthcare and social policy guideline development.(3, 4)

Comparative studies have shown CERQual to typically provide a more segregated picture than ConQual. ConQual is more likely to gather findings at moderate confidence as a result of downgrading, while CERQual’s multi-domain process detects high-confidence findings even in mixed-quality evidence bases.(8) This difference has made CERQual particularly more significant for international guideline panels looking for in-depth and context-sensitive judgments. Simultaneously, ConQual, owing to its efficiency, is only preferred in small-scale or rapid reviews where speed is crucial.(3-4)

Both frameworks underscore that confidence in qualitative evidence extends beyond methodological rigor to also focus on intensity, diversity, and relevance of the data. Experts recommend reporting confidence scores with domain-level justifications, backed by summary of findings tables. Novel digital tools, including the iSoQ platform for CERQual are enabling authors to enhance transparency,(9) while refinements in the ConQual guidance are underway to align with the evolving needs.(3, 4)

Finally, the choice of ConQual and CERQual relies on review purpose, data type, and end-user needs. ConQual provides efficiency, while CERQual offers granularity and is increasingly the standard in guideline-based work. In the end, rigorous, transparent application of any of these frameworks is the most important factor so that qualitative findings can be trusted to influence policy and practice.

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References

1. Sekhon M, de Thurah A, Fragoulis GE, et al. Synthesis of guidance available for assessing methodological quality and grading of evidence from qualitative research to inform clinical recommendations: a systematic literature review. MD Open 2024;10:e004032.
2. 3.3.15 Assessment of confidence of qualitative synthesised findings. 2025. [Accessed on 13^th Sept 2025]. Available online at: https://jbi-global-wiki.refined.site/space/MANUAL/864551003/3.3.15+Assessment+of+confidence+of+qualitative+synthesised+findings
3. Munn Z, Porritt K, Lockwood C, Aromataris E, Pearson A. Establishing confidence in the output of qualitative research synthesis: the ConQual approach. BMC Med Res Methodol. 2014; 14:108.
4. Gupta VA, Scott S, Tonkinson M, Jonsson P, Goodburn L, Duffield S. Quality in qualitative evidence: new best practice principles from NICE’s real-world evidence framework. J Comp Eff Res. 2025; 14(7):e250064.
5. Methodological advances in evidence synthesis. 2025. [Accessed on 16^th Sept 2025]. Available online at: https://jbi.global/news/article/methodological-advances-evidence-synthesis
6. Kantor J, Smrckova A, Zaman M, et al. A qualitative systematic review protocol for a synthesis of teachers’ and learners’ experiences with the Teaching and Learning Toolkit. Front. Educ. 2025; 10.
7. Eskandari A, Ebrahimi K, Yazdani H. Validation of meta-synthesis research with emphasis on the Conqual validation method. Methodology of Social Sciences and Humanities. 2025.
8. Cooper S, Leon N, Schmidt BM, et al. Applying GRADE-CERQual to Interpretive Review Findings: Reflections From a Cochrane meta-ethnography on Childhood Vaccination Acceptance. International Journal of Qualitative Methods. 2024; 23.
9. iSoQ – The interactive Summary of Qualitative Findings (iSoQ) tool. [Accessed on 13^th Sept 2025]. Available online at: https://www.cerqual.org/isoq/